This is the second of two articles by Maricar Hampton resulting from her 2010 New America Media Fellowship, supported by The Atlantic Philanthropies. You can read part one here.

Nurse Edel Pimentel believes that Filipino health care providers will be especially able to deal with the demands of the 78 million aging boomers in the United States -- plus their elderly parents -- once they enter a healthcare facility, because Filipinos are “natural caregivers.”

In the Philippines, she said, “We tend to take care of our loved ones ourselves until they die. We don’t put them in nursing homes; we just don’t have that,” said Pimentel.

The role of foreign-born health care workers is especially important now because the United States is facing severe shortages of nurses and other eldercare workers. One in six nursing aides and one in nine nurses in the United States are foreign born, according to a 2004 study by the Immigration Policy Center in Washington, D.C.

The Philippines has been especially important, because its health care education programs have long been patterned after that in the U.S. Also, American long-term care providers actively recruit health care personnel there, even though immigration concerns in the United States have slowed State Department approvals of work visas to a seven-year backlog.

A report by the Philippine Embassy on Filipino medical staff for the year 2008-2009, shows that a total of 1,887 nurses, 1,450 physical therapists and 229 occupational therapists in the Philippines have been recruited by, or have job orders to work for, different hospitals and nursing home facilities all over the United States. However the embassy is not sure whether these people made it to America or are still waiting back home.

Immigrants Fill U.S. Eldercare Shortages
Pimentel was only 23 when she was recruited away from her job as a hospital nurse in the Philippines by Potomac Valley Nursing and Wellness Center to come to its nursing facility in Maryland.
Like many of her colleagues, she initially found it difficult to adjust to her new circumstances. “When I came here it was a struggle; it was depressing being in a nursing home and working with them,” said Pimentel. Over the past 16 years, though, she became a nursing supervisor and data coordinator, and came to love her job.

Today, Pimentel is fortunate to be among the thousands of Filipino nurses and aides, who find satisfaction in providing long-term care to millions of older Americans. Many others who venture abroad as caregivers tell awful stories of abuse, harassment and broken dreams.

Even in non-abusive situations, long-term care staff can find themselves stuck on double shifts and assigned to too many facility residents. Despite doing the most difficult tasks direct-care nurses’ aides typically get paid hourly wages of $10 an hour or less, frequently without benefits.

Immigrants in nursing are particularly needed in geriatric care, because the fragmented U.S. system of long-term care attracts few health care providers, according to Robyn I. Stone, executive director of the Institute for the Future of Aging Services at the American Association of Homes and Services for Aging, in Washington, D.C.

Stone, a former head of the U.S. Administration on Aging, noted, “We have a coalition here in Washington called the Eldercare Workforce Alliance, a group of various associations that are all focused on really trying to get a better geriatric training, education and support for nursing and other health care professions.”

But until the United States finds ways to fill the shortages, Stone said, immigrants skilled in health care will continue to be vital in both institutional and home or community-based care, she said.

Not only registered nurses such as Pimentel, but nursing caregivers in long-term care, also known as direct care workers, have always played a key role in American eldercare. In nursing facilities, homecare or community-based programs, such as assisted living, direct caregivers provide most of the hands-on care.

In many states on the East and West coasts, caregivers are predominantly from other nations. A 2008 article in the Gerontologist, a journal of the Gerontological Society of America, Globalization, reported that the Philippines has become a major source of long--term care workforce for the U.S., Canada, and European countries and others. Many others come from Africa, the Caribbean and other developing regions.

Grueling Tasks
Direct-care workers in long-term care often perform grueling tasks, such as bathing and feeding frail elders, helping them use the bathroom, cooking, cleaning and serving meals. In addition, they administer basic first aid and, in some cases, are licensed to dispense medications and participate in the care planning process for residents.

“It’s all about interpersonal relationships with the residents,” he said. Mallon takes time to talk with residents, because “that personal touch” enables him to note subtle changes in a resident’s character that might tip him off to emerging issues in their care.

Direct-care workers, such as Melon, are the lowest paid employees in long-term care. Few work in settings that involve them on the caregiving team, or provide them longer-term career development.

That’s why turnover among direct care workers ranges from 40 to 75 percent annually nationwide, according to the 2009 Direct Support Professionals Wage Study, conducted by ANCOR, a trade group for direct-care providers. A 2001 report by the U.S. Government Accountability Office found that turnover has been as high as 100 percent in a year in some facilities.

Direct caregivers typically need one or more other jobs simply to make ends meet. Such is the case with Melon, who does private-duty caregiving on weeknights, and works in a group home on the weekends.

“I used to work in the mortgage industry. But with the real estate market going down, I had to look for an alternative source of income, which is in healthcare. But even then I still have to have two jobs,” Melon said.

Edita Baua, a patient-care unit manager , is one of Edel Pimentel’s nursing co-workers at Potomac Valley Nursing and Wellness Center in Maryland. “I came here as a tourist and wasn’t planning on staying for good,” she said. When a friend persuaded her to remain, she applied at Potomac Valley, where an administrator welcomed her and said the organization would sponsor Baua to become a legal U.S. resident.

Currently, Potomac Valley has petitioned the U.S. State Department for three nurses to receive American work visas. But the visas are yet to be approved because of the virtual “freeze” on them, Orlina said.

Pimentel remains hopeful. For Filipino caregivers, she said, the U.S. provides “fertile ground. There are a lot of opportunities for you to move up in this profession. A lot of Filipino nurses thrive and do well because it’s innate in us to be hard working, patient and caring which, in this job, is very much needed.”

As for those nurses trying to emigrate here, she, Pimentel said, “Yes, there is a big need for nurses in this country, but it is limited because of the government restriction. But I hope the U.S. will give them the opportunity to come here too and fill the shortage.”

They're not just live-in caregivers. Many are nurses who want to live and work in Canada.

For many Canadians, the image of a Filipino worker is one of a nanny pushing a baby carriage. But the reality is quickly changing. Lawrence Santiago, a Trudeau scholar doing his doctorate at the University of B.C., wants to dispel some stereotypes about Filipino workers in Canada.
As he puts it, only about 12 per cent of the total Filipino population in Canada arrives via the Live-In Caregiver program.
To make his case, Santiago chose to study health care workers from the Philippines.
B.C. has not recruited nurses en masse from the Philippines the way the Prairie provinces have in recent years. But they apply to come anyway. The province's College of Registered Nurses gets more applications for licences to practise nursing from the Philippines than it does from any other country.
Santiago set out to hear the voices of these workers, understand what happens when they leave the Philippines, and see how they eventually fit into Canadian hospitals and clinics.
His project started in a small Saskatoon house, returned to his native Philippines, and this month looped back to B.C.
His research has illuminated the many challenges involved with widespread migration, both here and in the Philippines.
On a personal level, nurses who emigrate for a brighter economic future are often wracked with homesickness and guilt for leaving their families.
Globally, the large-scale exodus of health care workers also takes a toll. The country they leave loses some of its best and brightest nurses and doctors, harming both the quality of health care and training for the next generation.
Last summer, Santiago camped out for several months with five nurses from the Philippines. They were all on temporary work visas, living in Saskatoon, the first batch of recruits hired by the Saskatoon Health Authority in 2008. His initial source was a childhood friend.
"Before he left for Canada, we met regularly in our town and at the community church," said Santiago.
From there, Santiago fanned out to meet and do in-depth interviews with other Filipino nurse migrants in Saskatoon.
"I lived with them in the same household, so I cooked, cleaned, played and did anything that a typical housemate would do," he explained.
His ability to speak to the nurses in Tagalog - and as the son of a middle-class, migrant construction worker himself - allowed him to "jell very quickly" with his subjects. Still, at times it wasn't easy to draw the line: when to be an objective observer and when to be a fellow Filipino.
One day while helping one of the migrant nurses Skype with an ailing father, Santiago wondered how exactly he should handle himself.
"I can eavesdrop in their private family conversation like an ethnographer who takes advantage or exploits his subjects' emotional circumstances, or I can simply stay away from the scene," wrote Santiago. "I decided to do what a friend would do instead. I cooked him sopas or milk macaroni soup, which he has been requesting from me to cook for the last few days because of the rainy weather here in Saskatoon.
"Managing one's emotions is one of the most difficult things migrants face while they're abroad. In situations [such as] when one's loved ones are sick, or worse, just died, the migrant feels a strong sense of fate's betrayal," he noted.
This April, Santiago moved his research to the Philippines to learn what happens on that end when nurses leave in large numbers.
"There is a huge strain on health care delivery in Philippine hospitals. The boom of nursing colleges in the Philippines has become a major business opportunity for many private entrepreneurs and institutions, enabling further migration," said Santiago. "But it has led to a deterioration of the quality of nursing education, since most of the best trained nursing faculty and clinical instructors are leaving the Philippines as well."
Over the next few weeks, Santiago will conduct focus groups with Filipino nurses who are working in B.C. (Some come on temporary work visas to take hard-to-fill positions, often in more remote locations. Some work first in other countries, such as the U.K., the U.S. or in the Middle East, before coming to Canada on temporary work visas or as immigrants under federal skilled worker programs. Still others come first via the live-in caregiver program and then go through many qualifying hoops to work as nurses again once they are permanent residents.)
Eva Mendez, a consultant at Health Match B.C., which places doctors and nurses throughout the province, hopes Santiago will focus on how these Philippine-trained nurses are doing at work.
"Do your peers relate to you as a member of the team as opposed to [being] a temporary foreign worker? If it's a matter of 'You're an RN, but you're not really one of us,' it can lead to a total breakdown of work dynamics. Satisfaction at work is the linchpin."
To promote his research, Santiago is organizing conferences and collaborating on a multimedia, documentary film project. His great hope is that all the players in this story of migration from the Philippines to Canada will somehow "meet" via his project and think of ways to improve education, health, labour and migration policies.jlee-young@vancouversun.com

By Haidee V. Eugenio
At least 22 Filipino nurses and auxiliary personnel in the Commonwealth of the Northern Mariana Islands (CNMI) have complained they have not been paid on time for as long as three months now.

Some nurses received partial payments for their salaries, but are still uncertain whether they would get paid in full or if they would get paid after all in the next pay period.

The 22 overseas health workers are employed by a private employment agency, Saipan Employment Agency and Services, for work in the CNMI, a U.S. territory some three hours away from Manila.

These Filipino nurses are assigned to the CNMI government-run Rota Health Center and Tinian Health Center, located in two other major islands of the CNMI.

In the CNMI’s capital island of Saipan, nurses in the government-run hospital are directly employed by the government and do not experience salary delays.

Filipino nurses in both Tinian and Rota do not want to be identified, fearing retaliation from either the employment agency or the CNMI government.

Since March 2010, nurses in Rota received payments covering only the hourly $4.55 minimum wage of their salaries, and not their complete hourly salary of $8.93 to $9.20 an hour.

These nurses’ employment agency, SEAS, has also been permanently barred and disqualified from hiring, renewing or employing foreign workers in the CNMI because of labor violations.

SEAS appealed the decision, but the CNMI Department of Labor upheld the debarment and disqualification. The agency can still appeal the latest decision.

The employment agency likewise said it has not been receiving payments from the CNMI government and, as a result, could not pay these Filipino nurses for the services they render at the government health centers.

CNMI lawmakers stepped in to identify funds to pay the nurses salary. However, the funding appropriated by lawmakers and approved by the governor could only cover partial payment of the salaries.

The Philippine Consulate General in Saipan could not be reached as of posting time.

Records from the Philippine Overseas Employment Administration show there are over 3,200 Filipino workers in the US territory as of 2009.

Four Filipino nurses filed a discrimination complaint before the US Equal Employment Opportunity Commission (EEOC) against a hospital that allegedly fired them for speaking their native language at work.
Nurses Corina Capunitan Yap, Anna Rowena Rosales, Hachelle Natano, and Jazziel Granada claimed the Bon Secours Health System terminated them without due process and dismissed them solely for speaking in their native tongue.

The hospital’s policy states that English is the principal language and must be the exclusive language spoken and written by all employees while on duty in the emergency department.

However, the nurses, who are being represented by the Migrant Heritage Commission, said that they do not recall speaking in Tagalog in front or while providing patient care in the Emergency Department. They admitted speaking in their native language only during breaks at the Nurses’ Station.

The nurses’ lawyer, Atty. Arnedo Valera had asked the EEOC to investigate the complaint and if the hospital’s English-only rule in the workplace violates the Civil Rights Act.

Valera cited prior findings of the EEOC which did not favor this rule, “There were previous findings of the EEOC that this is burdensome as a condition of employment because it creates a disparate treatment which leads to discriminatory practice”.

Valera added that based on the nurses’ claims, speaking Tagalog during break time does not impede their work.

He added that should the EEOC find probable cause in the nurses’ complaint, the commission will issue a right to sue, after which they will file a case against the hospital before the district court and seek punitive damages of up to $500,000 for all four nurses. - via Balitang America

The possible deployment of Filipino health workers to Norway will increase the country’s intellectual capital and wealth, the Department of Labor and Employment (DoLE) said on Saturday.

Labor Acting Secretary Romeo Lagman made the statement after disclosing that Filipino nurses and caregivers may likely be deployed to Norway as soon as labor and health officials of Norway and the Philippines finalized talks on the matter.

“There are still apprehensions on the part of Norway particularly on the issue of ‘brain drain’ and the language training,” Lagman said in an interview.

“But we have 60,000 nurses produced every year, and enrollment for such course is not going down. We have an oversupply of nurses and we do not see a draining in our medical pool by increasing our deployment overseas,’’ he said.

According to Lagman, most European countries are now looking at the impact of social migration and do not want to take advantage of countries that are experiencing the brain drain phenomenon.
Norway labor and health officials are expected to visit the Philippines within the year to continue talks on ways to create employment for Filipino health workers.

Norway is open for employment and has huge requirement for nurses, said Lagman.
Should the deployment of Filipino nurses to Norway pushes through, he said the Philippines will be gaining so much not only from the job opportunities but also from the skills learned by the workers while in that country.
Currently, he said the country offers good compensation for health workers ranging from $3,000 to $7,000 per month.

Earlier, Norway had opened its doors to Filipino engineers and offering salaries ranging from $5,000 to $7,000 per month.

Apart from Norway, Lagman said Denmark is also open for Filipino workers although details on possible employment are yet to be discussed. - via www.mb.com.ph